Deflux Injection for VUR

Patients with low grade VUR or mild incontinence with poor reserve for surgery do well with the injection of bulking agents like Deflux. This is a short procedure that can be done even under local anesthesia if the patient is cooperative. Deflux stays in place for many years and a large percentage of patients will be cured without any further treatment. Dr. Raman Tanwar carefully selects his patients for Deflux, advising this therapy in only those where it may work well.

How does Deflux work ?

Deflux® is a sterile, highly viscous gel of dextranomer microspheres (50 mg/mL) in a carrier gel of non-animal stabilized hyaluronic acid. It is deposited at the required site where it adds bulk and allows co-aptation of the mucosa there by preventing leakage of urine. Since the material is not degraded easily it stays in the injected site for many years. Deflux is essentially biocompatible and thus does not cause any harm to the body. It’s doses can also be safely repeated if needed.

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Figure Showing the Deflux needle and how Deflux in injected into the Bladder.

What are the pre-requisites for this Surgery ?

  • Deflux is effective in cases where the grade of Reflux is low
  • It may also be useful in cases of incontinence where artificial sphincter is not possible due to economic constraints and patient related factors
  • Deflux can also be advised when the patient ideally needs surgery but at the same time requires support to tide over the period prior to surgery
  • The general blood checkup should be good
  • There should not be any bleeding disorders
  • Patient should be convinced and willing to accept failure if it occurs.

What are the cost factors involved in Deflux Injection ?

The operative procedure is short and does not have a heavy cost but each 2 ml vial of Deflux is costly and some cases may need more than 1 vial. So essentially the cost concerns are because of the cost of the Deflux compound itself.

What are the steps of this procedure ?

As explained earlier, Deflux Injection is a rather simple urological procedure that may be done even under local anesthesia without need of any systemic toxic drugs and with minimal side effects.

  • We call the patients after light breakfast.
  • Public hair should be trimmed and patient should have had a shower prior to surgery to minimize infections.
  • A local anaesthetic jelly is injected per urethra 10 to 15 minutes prior to the procedure and a penile clamp is applied to retain the jelly in situ
  • Patient is made to lie down on the operating table in a lithotomy position and thorough cleaning is done with betadiene iodine scrub and solution.
  • Once you are covered with sterile sheets the cystoscope is inserted gently keeping in mind that there is no pain and the entire procedure is painless.
  • A ureteric catheter may be used to confirm the site of the orifice and keep the posterior wall exposed.
  • Deflux Injection is then instilled through a special needle and kept there for half to one minute.
  • The entire assembly is then removed and you may be shifted to the daycare room for observation.
  • Once you have passed urine, our team will sign off your discharge and you should be good to go.
  • If the procedure is not tolerable and in cases of children spinal or general anesthesia is used and a days stay in the hospital will be required to ensure your safety.

What is the course of treatment after the Deflux Injection ?

Once the injection has been given the status of reflux can be reviewed with repeated investigations after 4 to 6 weeks. During this period prophylactic antibiotic cover is continued. There are no other precautions that are required and the period of recovery is just one to two days.